Assessment of recurrent laryngeal nerve during thyroid surgery with laryngeal mask airway

Objective: To study the feasibility of using laryngeal mask anesthesia (LMA) with bronchoscopic evaluation of recurrent laryngeal nerve (RLN) integrity when stimulated. Design: Single-institution prospective case series. Setting: A single, mid-Atlantic region academic medical center. Patients: Twenty-seven adult volunteers. Interventions: Laryngeal mask anesthesia for thyroid surgery, monitored by flexible laryngoscopy and nerve integrity testing. Main Outcome Measures: Success rates for LMA use in thyroid surgery, bronchoscopic visualization of laryngeal glottis, and documentation of RLN integrity following surgery. Results: We report our experience on 27 consecutive cases in which LMA with RLN stimulation was used for thyroid surgery. Twenty-five of 27 patients underwent successful LMA and visual documentation of RLN integrity by bronchoscopic inspection of nerve stimulation. Conclusions: Direct visualization of vocal cords using a fiberoptic bronchoscope via an LMA provides a safe and feasible method of laryngeal assessment following thyroid dissection. Continuous real-time video monitoring may be the next step in development of this technique as a patient safety measure for thyroid and parathyroid surgery.